Form DS 621, also known as the "Statement of Financial Interests," is a form that all federal employees and officers must complete on an annual basis. The form requires individuals to disclose any financial interests they have that could potentially conflict with their government duties. Completing Form DS 621 is important for ensuring transparency and preventing conflicts of interest.
This quick guide can help you determine how long it'll require you to fill out form ds 621, how many pages it has, and a few other unique details about the file.
| Question | Answer |
|---|---|
| Form Name | Form Ds 621 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Deferred, apple bank online distribution form, affirm, RMDs |
IRA DISTRIBUTION FORM
Please complete all of the information requested below:
1. PLAN TYPE |
TRADITIONAL |
Apple Bank for Savings
BRANCH #/DEPARTMENT
PLAN #
ROTH |
SEP |
2. ACCOUNT OWNER INFORMATION
Name:
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Social Security Number: |
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Home Phone: |
Business Phone: |
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3.REASON FOR DISTRIBUTION
Regular Distribution (after age
Premature Distribution (before age
Death (complete Section 5; additional documentation required) Disability (additional documentation required)
Remove an excess contribution made for the current year Remove an excess contribution made for the prior year Other _________________________________
(conversion to Roth, Revocation, Recharacterization, etc.)
4. DISTRIBUTION INSTRUCTIONS |
Required Minimum Distribution (RMD)* |
Close Account(s) Specified Amount(s)
Other _______________________________
Interest only – Installment Payments: Monthly Quarterly
Installment payment based on Uniform Lifetime Table
Installment payments based on Joint Life and Last Survivor Expectancy Table Installment payments based on the Single Life Expectancy Table
*RMD’s not required for Roth during participant’s lifetime
Frequency:
Immediately
At Maturity |
Installments: |
Monthly
Quarterly
Annually
Please indicate month in which distributions are to start
Deferred Distribution: If you reach age
January
February
March
Federal Income Tax Withholding Election: You must select one, withholding options as noted below. If you do not we are required to automatically withhold from your taxable payments as required by Federal Law.
Do not withhold federal income tax from my payments
Withhold federal income tax from my payments (10%
I elect to have the amount of $ withheld from my distribution payment
Other percent |
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% |
1 of 2 |
Method of Payment
Check mailed to recipient’s address
Deposit to IRA owner’s Apple Bank Savings Account:
Checking, NOW, or Money Market Account #
Specify retirement account(s). List numbers below |
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Check mailed to recipient of funds in Section 5 Savings Account #
Special handling instructions
Specified Amount(s)
Please note that early withdrawals from time deposit accounts may result in interest penalties. See account disclosures.
5.DISTRIBUTION DUE TO DEATH
* The recipient’s signature must be guaranteed. Recipient of funds: |
Designated IRA beneficiary |
Legal representative of estate
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Business Phone: |
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6.AUTHORIZATION By signing this request:
You authorize us to make a withdrawal from the above Apple Bank IRA in the manner and for the reason indicated. You affirm that the withdrawal is permitted under the Apple Bank IRA and meets all legal requirements of the Internal Revenue Code. You acknowledge that Apple Bank may rely on your affirmation and is not liable for any tax or other consequences, nor for any penalties, however incurred in connection with this withdrawal.
Name of individual receiving funds (please print) |
Signature |
Date |
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7.Approved by APPLE BANK FOR SAVINGS
Authorized Signature |
Date |
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